Provider Demographics
NPI:1407077985
Name:GRAY, SELENA PAIGE (DC)
Entity Type:Individual
Prefix:DR
First Name:SELENA
Middle Name:PAIGE
Last Name:GRAY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7616 CULEBRA RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-1476
Mailing Address - Country:US
Mailing Address - Phone:210-509-2603
Mailing Address - Fax:210-509-2637
Practice Address - Street 1:7616 CULEBRA RD
Practice Address - Street 2:SUITE 130
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1476
Practice Address - Country:US
Practice Address - Phone:210-509-2603
Practice Address - Fax:210-509-2637
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6369111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L12533Medicare PIN